Tamar Wyte-Lake

The critical elements of effective academic-practice partnerships: a framework derived from the Department of Veterans Affairs Nursing Academy

BackgroundThe nursing profession is exploring how academic-practice partnerships should be structured to maximize the potential benefits for each partner. As part of an evaluation of the U.S. Department of Veterans Affairs Nursing Academy (VANA) program, we sought to identify indicators of successful partnerships during the crucial first year.MethodsWe conducted a qualitative analysis of 142 individual interviews and 23 focus groups with stakeholders from 15 partnerships across the nation. Interview respondents typically included the nursing school Dean, the VA chief nurse, both VANA Program Directors (VA-based and nursing school-based), and select VANA faculty members. The focus groups included a total of 222 VANA students and the nursing unit managers and staff from units where VANA students were placed. An ethnographic approach was utilized to identify emergent themes from these data that underscored indicators of and influences on Launch Year achievement.ResultsWe emphasize five key themes: the criticality of inter-organizational collaboration; challenges arising from blending different cultures; challenges associated with recruiting nurses to take on faculty roles; the importance of structuring the partnership to promote evidence-based practice and simulation-based learning in the clinical setting; and recognizing that stable relationships must be based on long-term commitments rather than short-term changes in the demand for nursing care.ConclusionsDeveloping an academic-clinical partnership requires identifying how organizations with different leadership and management structures, different responsibilities, goals and priorities, different cultures, and different financial models and accountability systems can bridge these differences to develop joint programs integrating activities across the organizations. The experience of the VANA sites in implementing academic-clinical partnerships provides a broad set of experiences from which to learn about how such partnerships can be effectively implemented, the barriers and challenges that will be encountered, and strategies and factors to overcome challenges and build an effective, sustainable partnership. This framework provides actionable guidelines for structuring and implementing effective academic-practice partnerships that support undergraduate nursing education.

A systematic review of strategies to address the clinical nursing faculty shortage.

This systematic review provides a comprehensive assessment of models used to expand the ranks of clinical nursing faculty. Nursing faculty shortages constrict the pipeline for educating nurses and make addressing the projected nursing shortage more difficult. Schools of nursing have denied admission to qualified applicants, citing insufficient numbers of nursing faculty as one major reason. Using key search terms in PubMed(®) and CINAHL(®), we identified 14 peer-reviewed articles published between 1980 and 2010 about models for expanding clinical faculty. Partnership models (n = 11) and expanded use of faculty resources (n = 9) were the most common strategies. Few (n = 8) studies assessed program efficacy. A need was identified for studies to assess the effect of alternative models on educational capacity and student performance and to examine the subcomponents of academic-practice partnerships and other innovative approaches to understand the essential factors necessary to implement successful programs.

Disaster Planning for Home Health Patients and Providers: A Literature Review of Best Practices

Individuals receiving care in the home are vulnerable during disasters due to high rates of chronic disease, cognitive impairment, functional limitations, and physical disabilities as well as dependence on life-saving treatments and equipment. Increasing disaster preparedness among home health care recipients decreases the likelihood of adverse health outcomes and lessens the burden on community hospitals and emergency responders. A literature review examined existing home health organization policies and procedures, lessons learned in the field, and expert recommendations for improving home-based patient disaster preparedness. This review addressed preparedness on three levels: organization, provider, and patient. The results (1) indicate gaps between established and recommended tools and policies and adopted policies, and (2) demonstrate marked differences in approaches to evaluation, classification, education, and triage between organizations.

Faculty Recruitment and Engagement in Academic-Practice Partnerships

AIM This study examines how prior teaching experience and academic training are associated with teaching roles, level of desired support, and satisfaction with the VA Nursing Academy (VANA). BACKGROUND In 2007, the Department of Veterans Affairs (VA) created VANA, funding partnerships between schools of nursing and VA health care facilities, in response to projections for a severe shortage of registered nurses. METHOD We conducted annual surveys with nurse faculty from partnership sites in 2011 (n = 133) and 2012 (n = 74). RESULTS Faculty reporting that VANA provided the right amount of support for curriculum development (p = .03) and teaching (p = .02) were more likely to report being very satisfied with VANA overall than those who did not. CONCLUSION Models of academic‐clinical partnerships that expand faculty can be successful. It is important that inexperienced faculty have training and support as they take on new teaching roles.

Modeling evacuation of a hospital without electric power

Hospital evacuations that occur during, or as a result of, infrastructure outages are complicated and demanding. Loss of infrastructure services can initiate a chain of events with corresponding management challenges. This report describes a modeling case study of the 2001 evacuation of the Memorial Hermann Hospital in Houston, Texas (USA). The study uses a model designed to track such cascading events following loss of infrastructure services and to identify the staff, resources, and operational adaptations required to sustain patient care and/or conduct an evacuation. The model is based on the assumption that a hospitals primary mission is to provide necessary medical care to all of its patients, even when critical infrastructure services to the hospital and surrounding areas are disrupted. Model logic evaluates the hospitals ability to provide an adequate level of care for all of its patients throughout a period of disruption. If hospital resources are insufficient to provide such care, the model recommends an evacuation. Model features also provide information to support evacuation and resource allocation decisions for optimizing care over the entire population of patients. This report documents the application of the model to a scenario designed to resemble the 2001 evacuation of the Memorial Hermann Hospital, demonstrating the models ability to recreate the timeline of an actual evacuation. The model is also applied to scenarios demonstrating how its output can inform evacuation planning activities and timing.

Modeling Hospitals' Adaptive Capacity during a Loss of Infrastructure Services

Resilience in hospitals - their ability to withstand, adapt to, and rapidly recover from disruptive events - is vital to their role as part of national critical infrastructure. This paper presents a model to provide planning guidance to decision makers about how to make hospitals more resilient against possible disruption scenarios. This model represents a hospitals adaptive capacities that are leveraged to care for patients during loss of infrastructure services (power, water, etc.). The model is an optimization that reallocates and substitutes resources to keep patients in a high care state or allocates resources to allow evacuation if necessary. An illustrative example demonstrates how the model might be used in practice.

Impact of VANA academic-practice partnership participation on educational mobility decisions and teaching aspirations of nurses.

This study reports findings assessing the influence of the Department of Veterans Affairs Nursing Academy (VANA) academic-practice partnership program on nurse decision making regarding educational mobility and teaching aspirations. We conducted national surveys with nursing faculty from VANA partnership sites in 2011 (N = 133) and 2012 (N = 74). Faculty who spent more hours per week in the VANA role and who reported an increase in satisfaction with their participation in VANA were more likely to have been influenced by their VANA experience in choosing to pursue a higher degree (p < .05). Sixty-nine percent of VANA faculty reported that they would be very interested in staying on as a VANA faculty member if the program should continue. Six measures were positively associated with VANAs influence on the desire to continue as faculty beyond the VANA pilot; support from VANA colleagues, quality of VANA students, amount of guidance with curriculum development, availability of administrative support, support for improving teaching methods, and overall satisfaction with VANA experience (p < .05). As the popularity of academic-practice partnerships grows and their list of benefits is further enumerated, motivating nurses to pursue both higher degrees and faculty roles should be listed among them based on results reported here.

A Crisis Within a Crisis: The Extended Closure of an Opioid Treatment Program After Hurricane Sandy

Disruptions in opioid treatment programs (OTPs) are common after major disasters. Highly regulated OTPs confront challenges when responding to extended closures following disaster. Following Hurricane Sandy in 2012, an OTP located at the Manhattan Veteran Affairs Medical Center (VAMC) closed for 5 months. Semistructured interviews were conducted with clinicians and administrators who participated in the evacuation of the Manhattan VAMC, including the co-located OTP program. The Manhattan OTP preemptively dispensed emergency take-home methadone doses. Following closure, emergency guest-dosing arrangements were made for approximately 100 Veterans with Veterans Affairs (VA) and non-VA OTPs throughout New York City. Fortuitously, a retired VA OTP at another facility was reopened and accredited expeditiously. OTPs must improve contingencies for emergency response. However, disruptions in methadone delivery and threats to patient safety are likely to continue until agencies with oversight authority of OTPs describe specifications for emergency alternate care sites during long-term disaster recovery.

Facilitators and Barriers to Preparedness Partnerships: A Veterans Affairs Medical Center Perspective

OBJECTIVE This study sought to understand facilitators and barriers faced by local US Department of Veterans Affairs Medical Center (VAMC) emergency managers (EMs) when collaborating with non-VA entities. METHODS Twelve EMs participated in semi-structured interviews lasting 60 to 90 minutes discussing their collaboration with non-VAMC organizations. Sections of the interview transcripts concerning facilitators and barriers to collaboration were coded and analyzed. Common themes were organized into 2 categories: (1) internal (ie, factors affecting collaboration from within VAMCs or by VA policy) and (2) external (ie, interagency or interpersonal factors). RESULTS Respondents reported a range of facilitators and barriers to collaboration with community-based agencies. Internal factors facilitating collaboration included items such as leadership support. An internal barrier example included lack of clarity surrounding the VAMCs role in community disaster response. External factors noted as facilitators included a shared goal across organizations while a noted barrier was a perception that potential partners viewed a VAMC partnership with skepticism. CONCLUSION Federal institutions are important partners for the success of community disaster preparedness and response. Understanding the barriers that VAMCs confront, as well as potential facilitators to collaboration, should enhance the development of VAMC-community partnerships and improve community health resilience. (Disaster Med Public Health Preparedness. 2018;12:431-436).

The Development of a Veterans Health Administration Emergency Management Research Agenda

Introduction: The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a “laboratory” for the development of evidence-based emergency management practices. Methods: We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA’s role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA. Results: Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities. Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities.